Objective:

To Identify the impact of different surgical approaches for lumbar degenerative disc disease (DDD) on complications, reoperations/readmissions and healthcare utilization.

Materials and methods:

We used ICD9/10 and CPT codes to extract data from MarketScan. Patients were divided into six groups: single-level anterior only (sA), single-level anterior + posterior (sAP), single-level posterior (sP), multi-level anterior (mA), multi-level anterior + posterior (mAP) and multi-level posterior only (mP). Outcomes of interest were cumulative complication rates, re-operation rates, re-admission, and healthcare utilization at 6-, 12- and 24-months.

Results:

Of 148,499 patients, 3% had single level anterior fusion and 54% had multilevel posterior procedures. Patients in mAP cohort incurred higher cumulative complication rates (21%) compared to sA (13%), sAP (15%), sP (14%), mA (18%) and mP (18%). ER admissions within 30-days were highest in the mA cohort (14%) followed by mAP (11%) and mP (8%). At 12- and 24-months, patients with mA procedures were most likely to have either new fusion or re-fusion (8% and 12%) followed by sA (7% and 10%), sAP (4% and 7%), mAP (4% and 8%) mP (4% and 7%) and sP (3% and 7%). Compared to mP cohort, patients in mA cohort incurred 1.2 times the overall median payments, whereas mAP and sA incurred 1.1 times the payments at 12-months. This difference was further reduced at 24-months.

Conclusion:

Multilevel anterior and posterior procedures are associated with higher cumulative complications and healthcare utilization compared to other procedures, the difference in healthcare utilization tends to decrease over 12- and 24-months.